The following lists palliative care research primarily conducted by Australian research groups. The list is based on application of the CareSearch search filter for palliative care to identify articles held within the PubMed database and corresponding to the strongest evidence. Articles have been selected based on relevance and new articles are added on a weekly basis.
Whilst not an exhaustive list, the aim is to keep the community informed by providing a snapshot of recent research findings and planned studies in the Australian setting.
Clapham S, Ayalew AA, Redwood L, Yates P, Auret K, Clark K, et al.
Background: Understanding how symptom outcomes vary by care setting helps optimize care.
Aim: To compare trajectories of severe symptom distress in the final week of life across community and hospital settings.
Design: This retrospective consecutive cohort study used point-of-care data from the Australian Palliative Care Outcomes Collaboration, which includes the Symptom Assessment Scale and Palliative Care Problem Severity Score. Mixed-effects logistic regression models were adjusted for clinical, demographic and temporal factors.
Settings/ participants: Australian palliative care services (n = 165) contributed data for people who died between July 1, 2019, and June 30, 2024.
Results: Of 141,691 patients,73.6% were inpatients; 61.0% had a cancer diagnosis. Severe symptom prevalence was generally low (<5%). After adjusting important factors, inpatients had higher relative odds of severe pain-related (aOR: 1.20, 95% CI: 1.10, 1.30) and breathing-related distress (aOR: 1.55, 95% CI: 1.40, 1.70) compared with community patients; the corresponding absolute risk differences (ARDs) were minimal (pain: +0.36 percentage points; breathing: +0.79 percentage points). Conversely, inpatients had lower relative odds of severe fatigue (aOR: 0.86, 95% CI: 0.79, 0.94) and insomnia (aOR: 0.74, 95% CI: 0.66, 0.84), with small ARDs (fatigue: -0.32; insomnia: -0.26). Over time, severe breathing-related distress increased significantly as death approached, while pain-related distress increased slightly. Inpatients were also less likely to experience family/carer issues (aOR: 0.78, 95% CI: 0.72-0.84), or other symptoms (aOR: 0.57, 95% CI: 0.53-0.61), with small ARDs (family/carer: -0.56; other symptoms: -0.26).
Conclusions: While some relative differences were noted between settings, absolute differences were minimal, suggesting clinically comparable outcomes. These national data show that severity of symptoms in the two care settings are similar, reassuring patients, families, and health care professionals.
Grose D, Corbett C, Walker A, Lim WK, Smallwood N, Zentner D.
Aim: More older adults are living with an implantable cardioverter defibrillator (ICD). Deactivation rates for those approaching end-of-life are low, risking undue distress and an undignified death. This scoping review aimed to determine the availability and content of hospital guidance documents regarding ICD deactivation towards end-of-life.
Method: Guidelines' databases from two Australian states (Victoria and South Australia) were systematically searched between September 2022 to February 2023, to identify all documents that specified guidance for ICD deactivation at end-of-life. Relevant documents were analysed using a pre-specified data extraction tool.
Results: Following screening of 59,662 documents from 94 health services providing acute, aged or palliative care, 11 were included. Most were from public (10, 91%), metropolitan (eight, 73%) health services. Guidance on timing of ICD deactivation discussions was limited; only two (18%) documents advised discussion at time of insertion, one (9%) at generator change and six (55%) during advance care planning discussions. Recommended criteria for ICD deactivation varied: people with a terminal illness (two, 18%), with an active do not resuscitate order (five, 45%), receiving end-of-life care (11, 100%), or at the person's request (seven, 64%). Nine (82%) recommended consent dialogue that deactivation does not cause/hasten death (eight, 73%) or deactivate pacing (eight, 73%), aims to promote a peaceful death (eight, 73%) and that reactivation is possible (eight, 73%).
Conclusions: There is a paucity of local health service guidance to support clinicians navigating ICD deactivation at end-of-life.
Kim B, Boustany C, Fethney J, Simpson JM, White K.
Purpose: This study aimed to report the incidence, common reasons, and associated risk factors for unplanned hospital presentations during chemotherapy treatment.
Methods: A secondary analysis using data from a randomized controlled trial containing hospital data for the first three cycles of chemotherapy of adult oncology patients in two tertiary hospitals in Australia. Descriptive statistics were used to report hospital utilization patterns. Poisson regression explored risk factors for unplanned presentations.
Results: Analyses included data from 346 patients; 115 patients (33%) made one/or more presentations during the first three cycles of chemotherapy. Of 144 unplanned presentations, 74 (51%) were made during cycle 1. Predominant reasons were fever with/without neutropenia (n = 50, 35%) and nausea/vomiting (n = 30, 21%). Fifty-two percent (n = 75) of unplanned presentations did not result in hospital admission. Of 346 patients, 70 (20%) had hospital admissions with a median length of stay of 3 days (IQR 2-7). Multivariable analysis identified the following as predictors for unplanned presentations: cancer stage (stage 1 vs stage 4: IRR 2.50, 95% CI, 1.28-4.89; P = 0.01) and cancer type (lung cancer vs breast cancer: IRR 2.25, CI, 1.26-4.01; P = 0.01).
Conclusion: Nausea/vomiting management support may be one area warranting improvement, a frequent reason for unplanned presentations that are potentially preventable. Such support will be most beneficial during the first treatment cycle, when most unplanned presentations occurred. A high proportion of unplanned presentations did not result in hospital admission, indicating an opportunity to manage some of the side effects within primary care or outpatient settings, rather than utilizing emergency department services.
Lee W, Nagla A, Wong ABO, Magann L, Lovell M, Mantle E, et al.
Purpose: Breakthrough cancer pain (BTcP) is an evolving clinical challenge, with limited guideline-specific direction. This study aimed to identify gaps in breakthrough cancer pain (BTcP) diagnosis and management in Australia and propose practical, evidence-informed actions to improve assessment, prescribing and equitable access to effective analgesia.
Methods: A gap analysis was conducted between September 2023 and September 2024, using three hybrid roundtable meetings involving 13 medical and nursing clinicians and researchers. Participants were selected for expertise in BTcP, including rapid-onset opioids (ROOs) policy development, BTcP research and education. A targeted review of the literature and guidelines framed the discussions. Meetings were recorded, transcribed and iteratively member-checked; thematic synthesis identified key gaps and potential solutions.
Results: Five interrelated gaps were identified: (1) inconsistent definitions of BTcP undermining case identification and research comparability; (2) assessment and measurement gaps with uptake of validated tools limited by perceived respondent burden and clinical utility; (3) heterogeneous approach to BTcP with limited comparative evidence guiding ROOs versus immediate-release opioid use and dosing strategies; (4) implementation and systems barriers including workflow, prescribing complexity and clinician training needs; (5) equity in opioid supply and restricted access to vulnerable populations. Recommended actions include Delphi consensus on definition, development and validation of subtype-sensitive assessment tools, pragmatic comparative effectiveness and implementation studies, co-designed prescribing templates and stakeholder engagement to address supply chain and regulatory barriers.
Conclusions: Sequential, coordinated efforts-consensus building, measurement development, targeted research, co-designed implementation supports and supply chain planning-are required to advance equitable, evidence-based BTcP care in Australia.
O'Brien T, Huckvale K, Metcalf O, Chapman W, Ferdous H, Hoda R, et al.
Abstract: Patients forget up to 80% of information conveyed during medical consultations. While clinicians may provide hand-written notes to patients during in-person appointments, such opportunities are limited in telehealth. Palliative care patients with complex information needs may benefit from consultation summaries. We developed a consultation summary application (CSA) to generate patient-facing summaries during video telehealth, in a palliative care context. Traditional research methods fall short in early identification and resolution of socio-technical factors, e.g., workflow compatibility, which impact the adoption of digital health innovations. Drawing on the Service Readiness Level Framework, we adopted a phased approach to generating evidence for the CSA. We conducted clinical simulations with seven clinician-simulated patient dyads involving the metastatic lung cancer scenario to examine and address usability and workflow integration issues prior to real-world implementation. Both clinicians and simulated patients perceived the CSA as a valuable tool to support palliative care patients with information recall and self-management. We recommend clinical simulation to de-risk real-world deployment, and optimise the digital health innovations.
Last updated 30 April 2024